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Abstracts Seminar Lunteren
Abstracts of the
seminar papers
Keynote speakers
THIERRY CHAUSSALET (UNIVERSITY OF
WESTMINSTER, LONDON, UK)
Short Bio
Thierry received was educated in France (first degree in mathematics)
and the USA (MSc and PhD in probability and stochastic processes, North
Carolina State University). He is currently Professor in Healthcare
Modelling at the University of Westminster, where he co-founded the
Health and Social Care Modelling Group (HSCMG)
(www.healthcareinformatics.org.uk
).
His research interests are in the
use of IT and modelling techniques in health care management, and the
development of tools that can aid healthcare decision-making. He has
been guest editor for various journals, and is currently associate
editor of Health Care Management Science and The Open Journal of
Medical Informatics. He is member of the Council of the (UK)
Operational Research Society (ORS), chair of the ORS Health and Social
Services special interest group, member of the EPSRC peer review
college and of the National Institute of Health Research –
Health
Technology Assessment peer review panel.
Title
Applications of Operational Research in healthcare: challenges
and opportunities
Abstract
The potential application of operational research to healthcare
management problems has stimulated a lot of interest in the past decade
in both academia and the health services in the UK and the rest of the
World. A few years ago the international review of the research status
of operational research (OR) in the UK, commissioned by the Engineering
Physical Sciences Research Council, identified applications of OR in
healthcare as one of the two “unique selling points of
significant strength within the British OR research, from an
international perspective.”
Analytical and mathematical approaches are underrepresented compared to
simulation based methods. It is often believed that one reason is that
simulation methods and their supporting user-friendly software are able
to better capture the complexity of the system and to make stakeholders
feel like participating in the model development process and the
interpretation of results. Yet several reviews of applications of OR,
mostly focussed on simulation, in healthcare in the past decade have
noted the lack of implementation or use of models. Does this suggest
total despair or give real hope for simple analytical/mathematical
models?
In this talk, we will give an overview of some OR applications in
healthcare, past, present, and future. Some questions will be raised
and answers developed about the need for, suitability, value, and
sustainability of research, implementation and knowledge transfer in
health care operational research.
ARMAND GIRBES (VU MEDICAL CENTER,
AMSTERDAM)
Short Bio
Armand Girbes is a professor in intensive care medicine at
the University Hospital VU medical centre. He is the head of the
department of intensive care and chairman of the division of surgery
and anaesthesia. His research focuses on vasoactive drugs, renal
function and hypothermia, apart from his involvement in organisational
issues in the Netherlands and Europe. He was recently an international
advisor of the Irish authorities for the organisation of intensive care
in Ireland. He is also very active in the European Society of Intensive
Care in the field of education and examination.
Title
Practical issues in patients logistics in the
intensive care
Abstract
Patients with a failure of one or more (vital) organ systems, or organ
systems at severe risk, require close monitoring and treatment in the
intensive care. Such critically ill patients can be patients after
planned major surgery but also - acute - patients who develop a life
threatening disease. Therefore patients can come in an intensive care
from different directions: unexpectedly from within the hospital and
from the outside, and planned after (semi-) elective surgery. Intensive
care is very much dependent upon human resources: sufficient nurses and
doctors and therefore the 24/24 and 7/7 continuity of care is
vulnerable and at risk in terms of continuous availability of
sufficient IC beds.
invited and contributed papers
SANDJAI BHULAI (VU UNIVERSITY AMSTERDAM)
Title
Personnel planning for care-at-home service
facilities
Abstract
Advances in health care have led to an increasing number of elder
people in society who want to continue living in their own homes while
needing medical care and care-at-home services (e.g., housekeeping).
This trend has led to a situation in which home care providers are
faced with a larger number of patients. At the same time, home care
providers have to provide care-at-home services with fewer resources
because of changing organization and finance structures and increased
competition. Therefore, efficient workforce management is essential to
provide a
high quality of service against low operational costs.
The distinguishing feature of the workforce management problem is that
service is provided for several hours in a week and for several weeks
consecutively. Hence, there should be enough capacity available once a
patient has been admitted for service. We provide a model to deal with
the personnel planning problem in care-at-home service facilities with
multiple patient classes. We derive optimal patient admission policies
and simple heuristics, given the demand for service, and study the
performance of these policies so that the size of the workforce can be
determined. Numerical experiments show that the heuristics have nearly
optimal performance.
RIENK BIJLSMA (SYSTEM
NAVIGATOR
& HOSPITAL NAVIGATOR, DELFT)
Title
Balancing between capacity and care
Abstract
Healthcare institutions & professionals have the joint
challenge of delivering maximum care with limited capacity and funds.
Hospital Navigator has developed a decision support system for bed
management, theatre planning & waiting list management based on
simulation technology. This system is used in the NHS, where it enables
hospital management & consultants to better predict and
understand the impact of new policies in regard to the use of resource,
and the delivery of care. This leads towards better informed decisions
regarding the delivery of maximum care, deployment of resource and
funding.
ALEIDA BRAAKSMA (AMSTERDAM MEDICAL CENTER)
Title
Integral multidisciplinary rehabilitation treatment planning
Abstract
At a rehabilitation outpatient clinic patients are treated to recover
from injury, illness, or disease to as normal a condition as possible.
To achieve this, patients require a series of treatments by therapists
from various disciplines. In current practice, a lack of coordination
between these disciplines, and the deficiency to plan the entire
treatment plan at once, is witnessed. This jeopardizes both quality of
care and logistical performance. Our integral treatment planning
method, that applies a combination of integer linear programming and
simulation, ensures continuity of care, while simultaneously
controlling performance indicators such as access times and
utilization. Applying our approach to a case study within the AMC shows
promising results.
NICO DELLAERT (EINDHOVEN UNIVERSITY OF TECHNOLOGY)
Title
Improving operational effectiveness of tactical master plans
for emergency and elective patients under stochastic demand and
capacitated resources
Abstract
This paper develops a two-stage planning procedure for master planning
of elective and emergency patients while allocating at best the
available hospital resources. Four types of resources are considered:
operating theatre, beds in the medium and in the intensive care units,
and nursing hours in the intensive care unit. A tactical plan is
obtained by minimizing the deviations of the resources consumption to
the target levels of resources utilization. Some capacity is reserved
for emergency care. To deal with the deviation between actually
arriving patients and the average number of patients on which the
tactical plan is based, we consider the option of planning a higher
number of patients (overplanning). To adapt the tactical plan to the
actual stream of elective patients, we also consider flexibility rules.
Overplanning and flexibility leads to a weekly schedule of elective
patients. This schedule is modified to account for emergency patients.
Scheduled elective patients may be cancelled and emergency patients may
be sent to other hospitals. Cancellations rules for both types of
patients rely on the possibility to exceed the available capacities.
Several performance indicators are defined to assess patient
service/dissatisfaction and hospital efficiency. Simulation results
show a trade-off between hospital efficiency and patient service. We
also obtain a rank of the different strategies: overplanning,
flexibility and cancellation rules.
PEER GOUDSWAARD (UNIVERSITY MEDICAL CENTER GRONINGEN)
Title
Lean Six Sigma; a tool for applied operations research at the
University Medical Center Groningen
Abstract
Hospitals today face major challenges; quality of care does not meet
patients’ needs and costs are exploding. In 2007 the
University Medical Center Groningen (UMCG) started to implement Lean
Six Sigma (LSS) as the approach to quality improvement and cost
reduction. One of the key reasons LSS has been so successful is not the
use of sophisticated statistical tools. It is the management and
organizational framework.
Typical LSS projects in the UMCG focus on length of stay, appropriate
use of medication, better use of operating rooms, and nursing
efficiency. But also on improving the administrative
infra¬structure; for example, distribution, purchasing, use of
energy, use of information and communi¬cation technology,
administrative and financial processes, etc. The LSS projects conducted
at UMCG were selected from all parts of the organization; nothing was
spared.
The results (successes and pitfalls) of a few typical LSS projects in
the UMCG will be shown. Together with the overall result of 2.5 years
LSS projects and future initiatives within the UMCG.
HAN HOOGEVEEN (UTRECHT UNIVERSITY)
Title
Personalized rosters for employees in a 24/7 environment at UMC
Abstract
We must roster 35 employees working 24/7 in three shifts with varying
mininum attendance. Each worker specifies personal preferences, like a
fixed day off. We have to find feasible year-rosters for each whose
combination occupies all duties. The goal is to maximize total roster
appreciation by the employees.
We solve this through column generation with a rolling horizon
approach. We determine many appreciable, feasible rosters for each
person, from which we pick one per worker. This resulted in an almost
optimal solution. Problems with more personnel are solved without
increasing the running time, and the results even get better.
PETER HULSHOF (UNIVERSITY OF TWENTE)
Title
Redesigning Ambulatory Care with a Doctor-travels-to-Patient
Policy
Abstract
In many hospitals, ambulatory care is organized such that doctors
remain in dedicated offices while patients come and go. However, with
demand for ambulatory care growing, outpatient clinics are looking for
methods to improve the efficient delivery of ambulatory care.
Therefore, a policy where patients wait and prepare in consultation
rooms, and care providers come and go, is considered.
We compare the alternative and classical approach and show under which
conditions the alternative is better. Additionally, we compute the
number of rooms required in the alternative approach. We discuss the
results for a case study in a general mid-sized hospital.
NIKKY KORTBEEK (UNIVERSITY OF TWENTE)
Title
Organizing Outpatient Clinics: Exploring the Viability of
Walk-in Based Policies
Abstract
Outpatient and diagnostic testing clinics have long provided patients
with appointments, so as to match capacity with demand. However, the
main disadvantage of a pure appointment policy is that substantial
access delays can be created. This study explores the viability of a
walk-in based policy: a mixed strategy of walk-in and appointments. We
present a stochastic method that finds the mixed strategy that achieves
an optimal balance between the benefits and drawbacks of a pure
appointment and a pure walk-in policy. The optimal policy successfully
counterbalances the non-stationary nature of walk-in arrivals at both
the daily and weekly levels, by prescribing how many appointment slots
to reserve and at which times.
PAULIEN OUT (VU UNIVERSITY AMSTERDAM & CC
ZORGADVISEURS)
Title
Optimal outpatient scheduling with emergency arrivals
Abstract
We present an efficient method for scheduling outpatient appointments
to a facility with emergency arrivals. A weighted sum of the waiting
times, idle times and tardiness is minimised. No-shows are allowed. We
assume Poisson arrivals for emergency patients and general iid service
times.We will present numerical examples.
ANJA STUNNENBERG (RIJNLAND HOSPITAL)
Title
Reorganizing and resizing clinical wards
Abstract
Last year a reorganization was required due to financial constraints.
Part
of the reorganization involved a reduction in the number of beds.
Despite
this reduction, our aim was to minimize the impact on the service level
for
patients. We considered several options, such as a ward of overflow
(flex
beds), a structural reduction in the length of stay and a smoother
admission pattern for scheduled patients. In this talk, I discuss the
practical and organizational issues that are accompanied by a
quantative
scenario analysis.
PETER VANBERKEL (UNIVERSITY OF TWENTE)
Title
An exact approach for relating recovering surgical patient
workload to the master surgical schedule
Abstract
No other department influences the workload of a hospital more than the
Department of Surgery and in particular, the activities in the
operating room. These activities are governed by the master surgical
schedule (MSS), which states which patient types receive surgery on
which day. In this paper we describe an analytical approach to project
the workload for downstream departments based on this MSS. Specifically
the ward occupancy distributions, patient admission/discharge
distributions, and the distributions for ongoing
interventions/treatments is computed. Recovering after surgery requires
the support of multiple departments, such as nursing, physiotherapy,
rehabilitation and long term care. With our model, managers from these
departments can determine their workload by aggregating tasks
associated with recovering surgical patients. The model, which
supported the development of a new MSS at the Netherlands Cancer
Institute-Antoni van Leeuwenhoek Hospital, provides the foundation for
a decision support tool to relate downstream hospital departments to
the operating room.
EGBERT VAN DER VEEN (ORTEC, GOUDA)
Title
On Capacity Planning in Health Care
Abstract
This presentation discusses some work in progress and research
perspectives on a capacity planning research in the care sector (care
for mentally and/or physically disabled persons). The goal of the
underlying problem is to determine an optimal workforce, indicating the
number of employees, the skill levels and the contract types of the
employees. This workforce is supposed to be able to cover the workload
that is implied by the client care indications (Dutch: ZZP-indicaties),
indicating the amount of care clients have right to receive. The
difficulty lies in translating ‘amounts of care’
into staffing levels and matching the right types of employees to
these.
LIESBETH VINKE (PLEXUS, BREUKELEN)
Title
Practical tools for optimizing bed allocation in hospitals
Abstract
Bed allocation within hospitals is often derived from former privileges
of the different medical specialties. This allocation, however, does
not always represent the actual demand for beds. In this session we
illustrate with practical examples how to re-allocate hospital beds by
means of historical bed usage data.
JAN VISSERS (INSTITUTE OF HEALTH POLICY AND MANAGEMENT,
ERASMUS UNIVERSITY ROTTERDAM)
Title
A European perspective on OR in Healthcare
Abstract
ORAHS is one of the domain specific EURO Working Groups installed by
EURO- the umbrella organisation for Operational Research in Europe. In
this presentation we report on the development of ORAHS as a European
platform for OR in health.
We propose a two-way framework for analysis, where one dimension is the
nine stages of the product life cycle: identifying consumer
requirements, designing a new service to meet these requirements,
forecasting demand for such a service, securing resources for it,
allocating these resources, developing programs & plans to use
these resources for delivering the service, establishing criteria for
service delivery, managing the performance of the service, and finally,
evaluating its performance. The other dimension is a three-level
classification into broad application areas referring to processes at
different levels in healthcare: patients & providers, units
&
hospitals, and regional & national.
We have used this framework to carry out a quantitative analysis of all
the papers presented during the meetings of ORAHS since its inception
in 1975. We then describe developments over this 35 year period in
applying OR approaches and techniques to health care, and present an
overview of the main application areas and challenges.
MAARTJE ZONDERLAND (UNIVERSITY OF TWENTE & LEIDEN
UNIVERSITY MEDICAL CENTER)
Title
Planning and scheduling of semi-urgent surgeries
Abstract
Semi-urgent surgeries, that have to be performed within the regular
operating room (OR) schedule shortly but not necessarily today, pose an
uncertain demand on available hospital resources, and interfere with
the planning of elective patients. For a highly utilized OR,
reservation of a fraction of OR time for semi-urgent surgeries avoids
excessive cancellation of elective surgeries, but may also result in
unused OR time, since arrivals of semi-urgent patients are
unpredictable.
We consider the trade-off between cancellation of elective surgeries
and unused OR time. First, using a queuing theory framework, we
evaluate the OR capacity needed to accommodate every incoming
semi-urgent surgery. Second, we introduce another queuing model that
enables a trade-off between the cancelation rate of elective surgeries
and unused OR time. Third, based on Markov decision theory, we develop
a decision support tool that assists the scheduling process of elective
and semi-urgent surgeries. We demonstrate our results with actual data
obtained from a department of neurosurgery.
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